Policy Manual


Service Planning      

Type: Procedure                 Category: Service Delivery                 Level: Community Care 

Parties: Community Care employees and contractees

Printer Friendly Version: http://apps.comcareme.org/policymanual/default.aspx?code=3.MEP.46&nonav=yes

Supporting References: COA General Standards G8.4, G8.5, and G8.6

Parent Effective Date Approval Level Revision Dates Last Reviewed
N/A  3-25-2004  Management Team    N/A
Related Document Code Related Document Name Type
3.MEP.20 Individualized Plan of Care Procedure

Procedure:  .

Community Care recognizes the need for all clients served to have an appropriate and individualized service or treatment plan. To that end, all Community Care programs will specify the manner in which services will be delivered to assist clients in reaching goals by developing an appropriate and individualized service plan, written in a timely manner, based as much as possible on the finding of an assessment, and involving to the fullest extent possible, the participation of the person, family, or group served.


1.      Each program will develop an initial or preliminary service/treatment plan within the allotted time frame below, with those cases requiring urgent attention developing the plan as soon as possible/prior to the requirement:

a.       Treatment Foster Care: Within 5 working days of admission,

b.      Residential Programs (ADAM House and Oakland Bridge Home): Within 72 hours of admission,

c.       Maine Caring Families: Within 5 days of placement-called a transition plan and to be developed at the transition meeting (to be held within 5 days of placement),

d.      Adoption Services: Prior to beginning services under a POS (Purchase of Services Agreement), and

e.       Community and Family Support Services: Within 30 days of admission required by regulations.

2.      Following the development of the initial or preliminary plan, each program will develop a comprehensive service/treatment plan according to the time frame mandated by licensing, within 30 days of admission for Treatment Foster Care, ADAM House, Oakland Bridge Home and Community and Family Support Services; or within 180 days for MCF.

3.      The service/treatment plan is developed with the full participation of the person served and/or his/her parent or legal guardian, as appropriate.

4.      Community Care will assist the person served to understand the options, the benefits, and consequences of various service alternatives, and the ways the agency can support the achievement of his/her desired outcomes. The options, benefits, risks and various service alternatives will also be explained in advance to the parent and/or legal guardian, as appropriate or required.

5.      The service/treatment plan is based on the assessment's findings and specifies:

a.       All services; how, and by whom the services will be provided,

b.      Service goals, including objectives, amount, scope, timing, and expected duration of each service element, and

c.       Desired outcomes.

6.      All service/treatment plan goals, strategies for achieving goals, and expected outcomes are:

a.       Goal directed and strength-based, and

b.      Focused on the timely resolution of the issues presented.

7.      Service/treatment plans, as well as significant revisions made to the plans (addendums), are signed by the person served and/or his/her legal guardian, as appropriate on or prior to the effective date of the plan.

8.      All participants in the clients treatment or service provision should be involved in the development of the plan and sign off prior to the effective date of the plan.

9.      As appropriate, and with the consent of the client and/or guardian, the client's birth parent may be involved in the service planning (unless contraindicated).

10.  As appropriate, and with the consent of the client and/or guardian, the client's birth parent(s) may be kept aware or advised of ongoing progress, and invited to case conferences/team meetings.

11.  The service/treatment planning process takes into account the permanency options for the client and plans for the following (concurrent planning may include both return to home and adoption as permanency options, both being pursued simultaneously):

a.       Return to home,

b.      Adoption,

c.       Another family-like permanent living arrangement such as kinship placement,

d.      Independent living, as appropriate, or

e.       Maintain the child in their current family situation.

12.  The permanency plan will be assessed with the development of each new plan, will document efforts to reunite and/or maintain the child with family/kin or other identified living situations, will assess the appropriateness of continued placement/need for continued services, and will encourage the parent/child/sibling/kin contact, as appropriate.

13.  Service/treatment plans will be updated no less than the time frame allotted by each program:

a.       TFC: every 90 days,

b.      Residential facilities: every 90 days,

c.       MCF: every 6 months,

d.      Adoption: with every new POS agreement, and

e.       Community Family Support Services every 90 days

14.  All service/treatment plans consider and recommend the most appropriate and least restrictive or intrusive service alternative possible to the person served.

15.  At the time of each service plan update, the emergency plan for the client will be updated, as well.

16.  When serving children in the custody of the parent and/or legal Community Care of Maine follows the procedures outlined in the Policy 3.ME.24, and Procedure 3MEP.26.